Posterior Circumflex Humeral Artery Research Articles

Anatomical and morphometric features of the profunda brachii artery.

When the literature is examined, studies evaluating the profunda brachii artery (PBA) are limited as most studies only investigate the artery's origin. In 44 upper extremities belonging to 24 human anatomical specimens, single and double PBAs were observed in 39 and five cases, respectively. In cases with a single PBA, the origin was the brachial artery (BA) in 35 cases and the posterior circumflex humeral artery in four cases. In cases with double PBAs, the artery's origin was the BA. Morphometric measurements of single and double arteries originating from the first branch BA were evaluated separately and compared according to sex and side. Our study, in which the PBA was examined morphologically and morphometrically, contributes to the literature anatomically and radiologically in treating humerus fractures and lateral arm-flap applications by surgeons.

The Recommended Deltoid Intramuscular Injection Sites in the Adult Population: A Cadaveric Pilot Study With an Orthopedic Perspective.

Background and aim The deltoid is a common site for intramuscular injections, but guidelines for administration lack standardization. Global researchers propose various techniques, and recent study reports indicate a 1.5-15% incidence of nerve palsies due to injections. This pilot cadaveric study aimed to standardize the deltoid intramuscular injection sites in the Southeast Asian population. Methods This cadaveric study of a two-year duration was conducted in the Department of Anatomy as an intramural research project in collaboration with the Departments of Anatomy and Orthopedics. In the first year of study, which was the pilot phase of the project, the available six cadavers, i.e., 12 upper extremity specimens were dissected. Anthropometric measurements of deltoid muscle along with the distance of underlying neurovascular structures like the axillary nerve and posterior circumflex humeral artery were measured from neighboring bony landmarks. This article presents the observations of the six cadavers studied in the pilot phase and shall be followed up by another article after the project. Results In adults, in anatomical position, the mean distances of the axillary nerveand posterior circumflex humeral artery from the mid-acromial point are 8.19±0.616 and 8.66±0.968 cm, respectively. The deltoid thickness at 3, 5, and 7 cm from mid-acromial point was observed to be 1.079±0.13 cm (0.5-1.78 cm), 1.599±0.12 cm (1-2.96 cm), and 1.815±1.0 cm (1.2-2.5 cm), respectively. The acquired qualitative and quantitative data were tabulated, graphically represented, and statistically analyzed. Conclusions The deltoid intramuscular injection (IMI) must be given at or below the level of the midpoint of the deltoid muscle, but never in the upper half. We recommend a site, 4 fingerbreadths/9 cm below the mid-acromion point as the safest site to avoid injury to any underlying neurovascular structures.

Results of transosseous suture fixation in four-part valgus impacted fractures of the proximal humerus

BackgroundThe osteonecrosis ratio in valgus impacted fractures of the proximal humerus is low (<10 %), giving osteosynthesis all its meaning. However, the optimal fixation technique remains controversial. After recentering the humeral head, osteosuture is stable enough to allow bone healing in an adequate position as well as a good long-term shoulder functionality. MethodsOur cohort included 22 patients with a mean age of 65 (28–83). Patients were placed in a beach-chair position. Surgical exposure was done through an anterolateral, transdeltoid approach. Stay sutures were placed on both tuberosities. Elevation of the humeral head was obtained for 9 patients using iliac crest bone graft, for 7 patients using bone substitutes, for 6 without any graft needed. Both tuberosities were approximated and tied together using two horizontal non-absorbable double-threaded sutures. The whole head was also tied to the humeral metaphysis by cerclage wiring using the same suture. Patients were immobilized in a sling for 4 weeks with no passive or active mobilization; then began rehabilitation starting with passive and active-assisted mobilization. Functional outcome was assessed with the Constant score. Radiographic follow-up was used for fracture healing and osteonecrosis signs. ResultsAll fractures united within the first 3 months. One patient had radiographic signs of osteonecrosis and one had a secondary displaced fracture without osteonecrosis. At an average follow-up of 35 months, the median Constant score was 83.7 % (63–100) in comparison to the uninjured side. DiscussionA preserved posteromedial periosteal hinge in a valgus impacted fracture of the proximal humerus is key to the success of osteosuture. This hinge provides mechanical stability to the humeral head once elevated, as well as blood-supply from the branches of the posterior circumflex humeral artery. Computed Tomography with Three-Dimensional reconstructed images allow for a precise analysis of this hinge as well as the vascularity of the humeral head. Osteosuture being a minimally invasive surgical procedure plays a predominant role in sparing the remaining vascularization of the humeral head. ConclusionOsteosuture in four-part valgus impacted fractures of the proximal humerus is a minimally invasive procedure as well as a reliable technique yielding good long-term results.

A Left Axillary Artery Variation: Case Report

Fetal abnormalities can cause axillary artery variations. Recognize and document of these variations are essential for surgeons performing interventional or diagnostic procedures for cardiovascular diseases. During routine dissection of an old female cadaver in the department of anatomy of Islamic Azad University, Tehran of Medical Sciences, we came across a variation in the branching pattern of the left axillary artery. The third part of the left axillary artery gave rise to a common trunk which was divided into the subscapular, lateral thoracic, posterior, and anterior circumflex humeral arteries.

Prevalence of Axillary Artery Variants and Their Clinical Significance: A Scoping Review.

Axillary artery (AA) variants occurred quite commonly, presenting clinical implications. A literature search yielded 523 resultsfrom which 13 parameters were extracted. Some of the AA variants found were the fusion of two or more branches into common trunks, like the fusion of anterior and posterior circumflex humeral arteries. Moreover, several branches were found to emerge from different points than expected, like the lateral thoracic artery's origin from the subscapular artery instead of the second part of the AA. The importance of the knowledge of the AA variations in clinical practice is undeniable and very useful when planning interventional procedures, as in the case of AA aneurysm treatment or in cases of fracture of the surgical neck of the humerus. The heterogeneity of data limited the possibility of a quantitative summary of data. Therefore, a more systemic study of AA variants based on the origin, course, and branching pattern is suggested. The aim of the current review is to summarize current data literatureregarding the AA typical anatomy and its variants, with a focus on their prevalence and possible clinical implications.

High bifurcation of the unilateral brachial artery: an unusual variation.

It is common to observe a high bifurcation of the brachial artery, with some variations being quite rare. During routine dissection for medical teaching purposes, a unilateral high bifurcation of the brachial artery was noted on the left side of a female cadaver. On the left arm, two branches of different sizes originate from the axillary artery, one on the radial side and the other on the ulnar side. These branches run down the arm, crossing each other, eventually becoming the forearm's radial and ulnar arteries. We also observed branches such as the posterior circumflex humeral artery, anterior circumflex humeral artery, and deep brachial artery. This case report adds to the existing body of knowledge about the variation of the brachial artery, which is of anatomical and clinical value. We report this case to highlight the unique variation in the arterial anatomy of the upper limb.

Collateral Artery from the 1st Part of the Axillary Artery: A Case Report

During radiological studies and surgeries, the branch architecture of the Axillary artery (AA) is crucial. Variations can complicate the interpretation of radiological data and cause unanticipated surgical complications. In the present situation, an uncommon collateral artery arose from the 1st part of the AA and gave rise to the lateral thoracic artery (LTA) and subscapular artery (SSA) before becoming the posterior circumflex humeral artery (PCHA). The SSA additionally gave rise to the thoracodorsal (TDA) and circumflex scapular arteries (CSA). For safe and effective surgical treatments and to prevent technical failures during catheterization and interventional procedures, it is essential to be aware of these anatomical differences.

Posterior Circumflex Humeral Artery Perforator Flap: A Cadaveric Study and Case Series.

Reconstruction of soft tissue defects of the acromioclavicular region represents a relatively uncommon but challenging event. Many muscular, fasciocutaneous, and perforator flaps have been described, including the posterior circumflex humeral artery perforator (PCHAP) flap based on the direct cutaneous perforator of the PCHA. This study aims to describe a variant of the PCHAP flap, based on a constant musculocutaneous perforator, by means of a cadaveric study and a case series. A cadaveric study was conducted using 11 upper limbs. The perforator vessels originating from the PCHA were dissected and the musculocutaneous ones were identified and measured in their length and distance from the deltoid tuberosity. Besides, we retrospectively analyzed the posterior shoulder reconstruction conducted among 2 plastic surgery department (San Gerardo Hospital, Monza and Hospital Papa Giovanni XXIII, Bergamo) using the musculocutaneous perforators of the PCHA. The cadaver dissection showed the presence of a constant musculocutaneous perforator arising from the PCHA. The mean pedicle length is 6.10 ± 1.18 cm, and the musculocutaneous perforator pierces the fascia at a mean distance of 10.4 ± 2.06 cm from the deltoid tuberosity. In all the cadaver dissected, the perforator of interest divided into 2 terminal branches, anterior and posterior, nourishing the skin paddle.In our case series, the mean age of the patients was 66.7 years, the mean size of the defect was 46 cm2, the mean operating time was 79.3 minutes, the mean length of hospital stay was 2.7 days, and the complication rate was 28.6%. According to this preliminary data, the PCHAP flap based on the musculocutaneous perforator seems to be a reliable alternative in posterior shoulder region reconstruction.

Quadrangular Space Syndrome: a systematic review of surgical and medical therapeutic advances.

The axillary nerve and posterior circumflex humeral artery are compressed in Quadrangular Space Syndrome (QSS), which can be treated with conservative approaches or surgical decompression in recalcitrant instances. There are no clear guidelines for determining which surgical method is optimal for treating QSS and other disorders that mirror QSS. The goal of this study is to grade and review past, current, and planned medicinal and surgical care modalities for QSS. The review protocol is registered with PROSPERO (ID: CRD42022332766). To identify recent advances in the methods/techniques of medical and surgical management of QSS, PubMed and Medline databases were searched until March 2022 for publications, including case studies, case reports, and review articles, using medical subject headings terms like quadrilateral space syndrome, surgical management, and medical management. Throughout the study, all the authors scrupulously followed a well-developed registered review process and the risk of bias in systematic reviews guidance tool. Data on proposed medical and surgical management methods/techniques were compiled, and each was analyzed based on the underlying neuro-vascular systems. There were 88 items found in the first search. Following applying the inclusion and exclusion criteria, 16 papers were chosen for synthesis in the review study after a thorough assessment. Three studies (conservative and advanced) focused on medical care of QSS, while 12 articles (prior, current, and newer) focused on surgical management of QSS. Only four of the 15 studies reviewed proposed different surgical approaches/techniques for surgical decompression in QSS. There were two regularly used surgical procedures discovered, one anterior/delto-pectoral and the other posterior/ scapular. The anterior route is more technically straightforward and can be employed for surgical QSS decompression.

The Posterior Circumflex Humeral Artery with Variant Origin and Course

The posterior circumflex humeral artery (PCHA) typically emanates from the axillary artery (AxA) that supplies the shoulder region and surrounding structure. During routine dissection, we noticed that a truncus profundocircumflexus arose as a branch of Brachial Artery distal to teres major (TM), which branches into profunda brachii, besides PCHA. This circumflex humeral artery, winding around the TM muscle, coursed superolaterally and reached the quadrangular space for its usual vascular territory. Adequate awareness of such rare variations observed in the present study is pertinent for physicians for quadrangular space syndrome, radiologists to avert misreading of angiographs, and orthopedics in case of trauma to the axilla, shoulder region, and upper arm or during invasive vascular procedures.

Thickness of the Deltoid Muscle and Location of the Anterior Branch of the Axillary Nerve and the Posterior Circumflex Humeral Artery for Deltoid Injections.

This study investigated the thickness of the deltoid muscle and the location of the anterior branch of the axillary nerve (AAN) and posterior circumflex humeral artery (PCHA), with the goal of maximizing the effectiveness of deltoid injections. Forty specimens from 22 adult Korean cadavers were used. A reference line was identified, connecting the anterior point of the deltoid muscle (AP) and the posterior point of the deltoid muscle (PP) on the surface. The midpoint between the AP and PP was used as the origin point (OP). The line connecting the OP and the lowest point of the deltoid tuberosity (DP) was used as the y-axis. The mean distance of the reference line from the AP to PP was 4.7 ± 0.7 cm. The vertical mean length of the deltoid muscle from the OP and DP was 16.1 ± 1.0 cm. At the 3, 5, and 7 cm sites, the thickness of the deltoid muscle was 0.62 ± 0.9, 0.73 ± 0.7, and 1.3 ± 1.1 cm, respectively. Most of the branches of the axillary nerve were concentrated in the third section (4-6 cm, 51%), while the branches of the PCHA were predominantly found in the fourth section (6-8 cm, 69%). The peripheral branches of the AAN entering the muscle were distributed between 2.2 and 9.8 cm from the acromion. The mean number of the peripheral branches of the AAN was 9.6 ± 3.4. In the deltoid muscle, the mean number of peripheral branches of the PCHA was 8.2 ± 2.8. Administering deltoid injections 5-6 cm below the OP is recommended to avoid axillary nerve injury.

Safety and short-term outcomes of anatomic vs. reverse total shoulder arthroplasty in an ambulatory surgery center.

A scarcity of literature exists comparing outcomes of outpatient anatomic (aTSA) and reverse total shoulder arthroplasty (rTSA). This study was performed to compare early outcomes between the 2 procedures in a freestanding ambulatory surgery center (ASC) and to determine if the addition of preoperative interscalene nerve block (ISNB) with periarticular liposomal bupivacaine injection (PAI) in the postanesthesia care unit (PACU) would improve outcomes over PAI alone. Medical charts of all patients undergoing outpatient primary aTSA or rTSA at 2 ASCs from 2012 to 2020 were reviewed. Atotal of 198 patients were ultimately identified (117 aTSA and 81 rTSA) to make up this retrospective cohort study. Patient demographics, PACU outcomes, complications, readmissions, reoperations, calls to the office, and unplanned clinic visit rates were compared between procedures. PACU outcomes were compared between those receiving ISNB with PAI and those receiving PAI alone. Patients undergoing rTSA were older (61.1 vs. 55.7 years, P<.001) and more likely to have American Society of Anesthesiologists (ASA) class 3 (51.9% vs. 41.0%, P=.050) compared to patients having aTSA. No patient required an overnight stay. Time in the PACU before discharge (89.1 vs. 95.6 minutes, P=.231) and pain scores at discharge (3.0 vs. 3.0, P=.815) were similar for aTSA and rTSA, respectively. One intraoperative complication occurred in the aTSA group (posterior humeral circumflex artery injury) and 1 in the rTSA group (calcar fracture) (P=.793). Ninety-day postoperative total complication (7.7% vs. 7.4%), shoulder-related complication (6.0% vs. 6.2%), medical-related complication (1.7% vs. 1.2%), admission (0.8% vs. 2.5%), reoperation (2.6% vs. 1.2%), and unplanned clinic visit (6.0% vs. 6.1%) rates were similar between aTSA and rTSA, respectively (P≥.361 for all comparisons). At 1 year, there were 8 reoperations and 15 complications in the aTSA group compared with 1 reoperation and 8 complications in the rTSA group (P=.091 and P=.818, respectively). Patients who had ISNB spent less time in PACU (75 vs. 97 minutes, P<.001), had less pain at discharge (0.2 vs. 3.9, P<.001), and consumed less oral morphine equivalents in the PACU (1.2 vs. 16.6 mg, P<.001). Early postoperative outcomes and complication rates were similar between the 2 groups, and all patients were successfully discharged home the day of surgery. The addition of preoperative ISNB led to more efficient discharge from the ASC with less pain in the PACU.

Surgical Implications in Multiple Variants in the Axillary Artery

The third segment of the axillary artery (TSAA) contributes crucial irrigation to muscles in mostly all compartments of the upper limb. Numerous studies have reported atypical branching patterns of the TSAA, which creates obstacles in operative assessments involving structures irrigated by this segment of the artery. In our current study, we observed three atypical branching patterns in the TSAA in which the subscapular artery gave rise to the posterior humeral circumflex artery and a second subscapular artery. In addition, a variant was found in the origin of the thoracodorsal artery; two collateral horizontal arteries irrigating the deep medial surface of the latissimus dorsi. Anatomical variants, not only in the axillary artery but in the whole body, have a remarkable importance in surgery as a whole and are a cause of the continuous adjustment of surgical standards and patient management. In this case report, we aim to evaluate these variants from a clinical perspective for the proper management of axillary traumas and pathologies.

Quadrangular Space Decompression

Background: The quadrangular (or quadrilateral) space is defined by its anatomical borders and is the passageway for the axillary nerve and posterior circumflex humeral artery (PCHA). Quadrangular space syndrome (QSS) can present due to various compressive pathologies but is commonly seen in overhead athletes. Quadrangular space syndrome can present with neurogenic symptoms including pain and paresthesias, as well as vascular complications from compression of the PCHA including thrombosis, aneurysm formation, and distal emboli. Indications: Surgical decompression of the quadrangular space is indicated for severe neurogenic or vascular compromise in the case of QSS refractory to nonoperative treatment. Technique Description: After appropriate preoperative physical examination findings and trial of nonoperative treatment, including physical therapy and injections, surgical decompression was indicated. The posterior border of the deltoid was marked, and an incision centered over the posterior border of the deltoid lateral to the axillary fold was made. Posterior border of deltoid was identified and retracted, revealing the interval of the teres minor and major. The nerve to the teres minor was identified, protected, and fibrous bands compressing the nerve were released. The nerve to the teres minor was tracked deep to find the axillary nerve. This was identified and fibrous bands around the nerve were decompressed. The circumflex vessels were protected throughout. Following decompression of the nerves, there was free movement of the nerves indicating adequate surgical decompression. Results: Adequate surgical decompression of the axillary nerve and PCHA achieved with resolution of neurogenic symptoms of pain and paresthesias at first postoperative visit. Discussion/Conclusion: Quadrangular space syndrome is a rare disorder, can be difficult to diagnose, and is the cause of significant morbidity, particularly in overhead athletes. If symptoms persist after nonoperative treatment, operative decompression of the quadrangular space may be indicated. Adequate surgical decompression results in relief of neurogenic and vascular symptoms.

Revisiting the Surgical Approaches to Decompression in Quadrilateral Space Syndrome: A Cadaveric Study.

BackgroundQuadrangular space syndrome involves compression of the axillary nerve and posterior circumflex humeral artery. In a few cases, its management requires surgical decompression. The current study reviews the surgical approaches used in the decompression of neurovascular structures and presents our reflections and recommendations.MethodologyIn this study, four human cadavers were used for dissection of the axillae and the scapular region by the senior residents of the Department of Anatomy and Department of Orthopedics. The residents dissected the quadrangular space in the eight upper limbs using anterior and posterior surgical approaches.ResultsTo identify the quadrangular space and secure its contents, the posterior approach was recognized as the easier and quicker method by both Anatomy and Orthopedic residents; however, it may result in increased postoperative morbidity. Although the anterior (deltopectoral) approach involves more skill, it reduces postoperative morbidity.ConclusionsThe anterior (deltopectoral) approach with suggested modifications can be an effective method in the surgical decompression of quadrangular space syndrome. The authors suggest more cadaveric studies to provide anatomists and surgeons with the opportunity to practice and evaluate older and newer surgical approaches.

Unusual Multiple Arterial Variations of the Upper Limb

During routine dissection of a 64-year-old male cadaver, multiple variations were observed in the arteries of the upper extremities. The first part of the axillary artery did not give any branches. The second part, after giving superior thoracic and thoracoacromial arteries divided into deep and superficial brachial arteries. Superficial brachial artery gave lateral thoracic artery and continued into the arm. After giving anterior circumflex humeral artery, the deep brachial artery trifurcated into the subscapular artery, posterior circumflex humeral artery, and profunda brachii artery. Understanding upper limb arterial variations are important for performing safer clinical procedures.

Unilateral Double Subscapular Artery: A Case Report

Variations in the Subscapular Artery (SA) are among the most common variations in the Axillary Artery (AA) and its branches. However, the occurrence of a common trunk from the third division is unusual. Hereby, authors report an atypical variation in the distal division of the axillary artery found during routine dissection of an elderly female cadaver. In this donor, the third portion of the AA gave rise to an SA, a common trunk, and the anterior circumflex humeral artery. In addition, the common trunk gave rise to a second SA, the posterior circumflex humeral artery, the scapular circumflex artery, and the thoracodorsal artery. Both SA branches appeared to irrigate the subscapularis muscles. Comprehension of the diverse anatomical variations of the subscapular artery is critically important in surgical procedures and therapeutic interventions for the upper limb.

Variable Origin of Axillary Artery Branches in Indian Male Cadaver- A Case Report

In clinical and surgical procedures, the variable origins of the axillary artery branches are significant for identifying uncommon symptoms and signs. The present case report documents an unusual origin of the axillary artery branches during dissection of a male cadaver in the anatomy department of an undergraduate and postgraduate teaching medical college in India. Normally, the superior thoracic artery arises from the first part of the axillary artery. In the present case, the second part of the axillary artery gave rise to a common trunk, from which the thoracoacromial, lateral thoracic, and subscapular arteries originated. Further, the thoracodorsal, circumflex humeral, and posterior circumflex humeral arteries originate from the subscapular artery whereas the anterior circumflex humeral artery only originates from the third part of the axillary artery. During surgical procedures performed in the region of the axilla, anatomists, radiologists, and cardiologists need to be aware of variations in the origin of axillary artery branches. During surgical procedures performed in the region of the axilla, anatomists, radiologists, and cardiologists need to be aware of variations in the origin of axillary artery branches.

Quadrilateral space syndrome.

The quadrilateral space is a confined area through which the axillary nerve and posterior circumflex humeral artery (PCHA) travel in the shoulder. Both structures are susceptible to impingement and compression as they travel though this space resulting in a constellation of symptoms known as quadrilateral space syndrome (QSS). Patients may experience paresthesias, loss of motor function, pain and vascular complications. Individuals who perform repetitive overhead arm movements such as elite athletes are at greater risk of developing QSS. The diagnosis can be difficult, but in the setting of clinical suspicion, physical exam and imaging studies can provide specific findings. On MRI, patients may have atrophy of the deltoid or teres minor muscles and angiography may show aneurysm or vascular occlusion of the PCHA. Treatment is initially conservative, with physiotherapy. Surgical decompression is effective in patients with severe or progressive symptoms. Causes of external compression such as fibrous bands, scarring, or other space occupying lesion may be addressed at that time. Neurolysis and aneurysm resection may also be performed. In some cases, emboli from the PCHA can cause ischemia in the involved upper extremity resulting in an acute presentation. Catheter directed therapy such as thrombolysis or thrombectomy may performed emergently in these cases. Though rare, in patients presenting with arm weakness, paresthesia, pain and/or arterial thrombosis in the arm, QSS is an important entity to consider.

Variations of the branches arising from the third part of the axillary artery: a cadaveric study

Objectives: This study aims to describe variations of the third part of the axillary artery branches with respect to their diameter, origin, subsequent branches, and gender. Methods: One-hundred and forty cadaveric shoulders were examined bilaterally in the Centre for Anatomy and Human Identification, University of Dundee, which is regulated by Human Tissue Act (Scotland) 2006. Branches arising from the third part of the axillary artery were dissected and the diameter, origin, subsequent branching patterns of each branch were documented, as well as gender. T-tests and chi-square tests were used to determine the association between the variables. Results: The most common variations were associated with the posterior circumflex humeral artery (48.3%), followed by the anterior circumflex humeral (25%) and subscapular arteries (16.7%). Variations of the anterior circumflex humeral artery were more common in females than males (p&lt;0.05). A significant association between the origin of posterior circumflex humeral artery and its subsequent branching pattern was observed. In females, the anterior circumflex humeral artery was more likely to give rise to the profunda brachii when it originated from the posterior circumflex humeral artery. Conclusion: Branches of the third part of the axillary artery vary in diameter, origin and subsequent branching patterns and the gender. An understanding of these variations is essential for accurate radiological diagnostic interpretation and therapeutic intervention. The difference in the variations observed and those reported in the literature suggest the need for further large scale studies.